The total number of COVID-19 cases in the USA surpassed ten million or 3% of the population today.  The third wave of the Pandemic in the USA is here and it looks extremely dangerous.  For the first time, the number of confirmed cases per week has reached 700,000 or more than 100,000 per day – 50% higher than the peak of the summer wave reached in July (see brown squares in the figure below).  Cases are rising everywhere this time around in contrast to the first wave which was concentrated in the Northeast and the second wave that was concentrated in the Sunbelt. 

This third wave differs significantly from the first and modestly from the second in other ways.  Testing now is much more thorough than the first wave and slightly better than the second wave thus identifying more asymptomatic and mildly symptomatic cases than before (see figure below).  More kids and young adults are being tested now increasing the percentage of silent carriers.  

But the new cases are not all benign as new hospitalizations, albeit with a longer lag time and lower hospitalization ratio have risen steadily since 9/20 (see blue diamonds in the first figure above).  During the first wave patients were so sick they were hospitalized within a few days of diagnosis.  During the second wave, the lag time increased to about a week and those requiring hospitalization decreased by half.  The lag time now appears to be 2 weeks.  Given the rapid increase in case counts, we are forecasting that hospitalizations (currently near 55,000) will exceed the previous peaks of 60,000 by next week and set new records that will stress many hospital systems just a week or two before Thanksgiving. 

Even though hospitals are better prepared this time around with PPE, ventilators, improved treatment techniques (proning), and better therapeutics (Remdesivir, dexamethasone, and monoclonal antibodies), they could still be stressed and cause death rates to exceed those reached this past summer and challenge the horrific levels reached this past spring.  Better medicine plus wider testing and lower median ages had reduced the hospitalization ratio and improved the case fatality rate (CFR) from near 7% to 1.6%. But these favorable factors may be offset by new stresses on the healthcare system.  Deaths rates have already been creeping up since bottoming near 720 per day on 10/17 to near 950 per day (see blue diamonds in the figure below).  We are forecasting that the death rate will double to 1,440 per day by month-end.  The news could get substantially worse if nothing is done immediately.     

Now that the election has passed, the USA must depoliticize the war against COVID-19 and work together to flatten the curve to save lives.  To avoid the worst-case scenarios, pandemic fatigued individuals must agree to wear masks, social distance, and wash hands as recommended by the CDC.  The government must increase testing availability and turnaround times, improve contact tracing, and set up selective quarantining facilities to monitor and reduce community spread.  The Federal government must coordinate equipment acquisition and distribution to ensure no shortages occur this time around.  The next 74 days are crucial if we want to ensure that the case count does not more than double with another 10 million cases and the death count does not increase by more than another 160,000 Americans.